Tag Archives: Babies

Breastfeeding and ethnicity

Helping more mothers breastfeed is a policy goal shared by many governments. Advocates argue that breastfeeding has a positive impact on a child’s physical, cognitive and behavioural development. Because of overlaps with other factors such as a mother’s social class or education, it is hard to measure precisely the degree to which breastfeeding alone benefits a child, but most policy-makers accept there is a benefit and want to know how to encourage more mothers to start it and stick with it. The incidence of breastfeeding varies significantly between women with different ethnic backgrounds and in different ways in the UK and US. Professor Yvonne Kelly from the ESRC International Centre for Lifecourse Studies at UCL asks if there are clues here as to how best to encourage women from different backgrounds to breastfeed their children.

The UK has one of the lowest breastfeeding rates in the world, although according to the NHS Infant Feeding Survey of 2010, the proportion of babies breastfed at birth is 81%, up from 76% in 2005. At three months, the proportion of mothers breastfeeding exclusively is 17%. At six months, the figure is just 1% and that has not changed since 2005.

The same survey found that breastfeeding was most common among mothers who were: aged 30 or over, from minority ethnic groups, left education aged over 18, in managerial and professional occupations and living in the least deprived areas.

The fact that younger, less educated, less well-off women are less likely to breastfeed is not surprising. Indeed, encouraging breastfeeding is at least partly about reducing inherited disadvantage. What may be less obvious (to the majority population, at least) is that ethnicity appears also to be a significant factor.

Millennium Cohort Study

When we looked at the data in the Millennium Cohort Study, which has been tracking the lives of some 20,000 children born at that time, we saw that well over 90% of Black African and Black Caribbean mothers at least started breast feeding.

The figure was over 85% for Indian and Bangladeshi mothers, 75% for Pakistani mothers and 67% for white mothers. Even after adjusting for demographic, economic and psychosocial factors, the difference remains significant.

At three months, with a range of factors considered, Black African mothers are more than 5 times more likely than white mothers to have started and continued to breastfeed. Clearly, if we understood why Black mothers were more likely to breast feed than white mothers we might have a better understanding of how to encourage all mothers to breast feed.

US comparison

An important part of our efforts to gain a clearer picture was to look for similar patterns in similar countries. So we did a comparison with the United States, where the overall rates for breastfeeding are very similar to the UK, as are the links between breastfeeding and socioeconomic status. Not at all similar, however, are the links between ethnicity and breastfeeding.

In the US, the highest rate, according to the National Immunization Survey in 2002, was among Hispanic mothers, at 80%. 72% of white mothers initiated breastfeeding. Only 51% of non-Hispanic black mothers did. So, in the UK black mothers are the most likely to breastfeed. In the US, they are the least likely.

Why the difference, given that usually, health problems suffered disproportionately by black Caribbean people in the UK affect black Americans similarly. Is there a mistake somewhere? We consider the possibility of recall bias in light of the fact that data were collected when the children were 9 months old.

It does seem reasonable to suspect mothers might want to believe they did more breastfeeding than was actually the case. But there is no obvious reason why that bias should apply differently in the UK and US. As the study suggests, the contrasting findings in the UK and US raise important wider questions about the nature of ethnic disadvantage.

One possible answer is that differences in breastfeeding reflect strength of cultural tradition and degree of “integration”. This, of course, can vary for similar ethnic groups in different “host” communities. The important thing is not the ethnic group itself, but the relationship between it and the rest of society.

Dominant cultural practices

Our study found that those who spoke only English at home were less likely to breastfeed. That raises the concern that as incoming groups adopt dominant cultural practices, their tendency to breastfeed will reduce. Cultural factors certainly merit further investigation, given that the only thing we considered in this study was whether English was the main language spoken at home.

Black people in the UK and black people in the US have different histories and, therefore, different identities. There are differences, too, in their “host” communities. In this instance, the very different health systems could be particularly relevant. Maybe future research should concentrate on this relationship rather than the behaviour of groups defined by characteristics that appear to have only secondary significance.

Those responsible for developing and implementing policies aimed at increasing breastfeeding rates in this area would certainly be advised to pay close attention to the different social, economic and cultural profiles of all ethnic groups.

Racial/ethnic differences in breastfeeding initiation and continuation in the United kingdom and comparison with findings in the United States  is research by Yvonne Kelly, Richard Watt and James Nazroo and is published in Pediatrics, Official Journal of the American Academy of Pediatrics..

Photo credit: US Breastfeeding Committee

 

Can a child’s ethnicity tell us something about asthma?

Asthma and wheezing illness are some of the most common childhood illnesses, and appear to have been on the rise in many developed countries. In the ongoing battle against them, considerable research has looked at the links with the surroundings we live in. From the effects of cold weather to dusty homes and living in polluted cities, hundreds of academics and health professionals have tried to put their finger on what external factors might be playing a role in children’s poor health.

Few researchers have looked to see whether there may be a story to tell about links with a child’s ethnicity and whether certain ethnic groups are at higher risk of wheezing illnesses. But now, as part of a wide-ranging ethnicity research project, a team based at the ESRC International Centre for Lifecourse Studies at UCL has been doing just that, as Lidia Panico explains.

About one in five British children has been diagnosed with asthma by a doctor, according to figures from the Health Survey for England, which also shows that wheezing is most common among Black Caribbean children, while Bangladeshi and Black African children suffer least.

A systematic review of UK studies has also found that South Asian children have lower rates of asthma and wheezing illnesses than the general population. In the US, Black children are twice as likely to suffer from asthma than White children. So why do these ethnic differences exist and can they inform our efforts to tackle the problem?

There are quite a few challenges around research in this area and real evidence is thin on the ground, especially when it comes to very young children. Studies have tended to group children from different ethnic backgrounds together or focus only on school age children. Numbers aside, very few studies have been able to go a step further and try to look at what might be behind any observed differences.

Background and biological factors

In our research, we made use of the Millennium Cohort Study, which has been following the health and development of some 20,000 children born in the UK around the turn of the century. This fantastic study has lots of data. This enabled us to look at a host of background and biological factors that might be at play. We looked at the children when they turned 3 years old.

We were able to look at household income, whether mum and dad had jobs and what those jobs were, mum’s age when she gave birth to the child and whether mum lived on her own.

When it came to potential biological causes, we could look to see if parents were smokers, whether the child shared his or her home with other siblings, potentially increasing the risk of catching common infections, furry pets and whether the child had been breastfed.

Other things taken into consideration were whether English was spoken at home and parents’ migration status.

Survey respondents (usually the mother) were asked whether the child had ever suffered from asthma and whether they had had problems with wheezing in the previous 12 months.

Facts and figures

Around one in ten of the children had suffered from asthma at some point while two in ten had wheezed in the last year. Around a fifth of those who had been wheezy in the last year had had more than four attacks in that period with nearly a quarter of them had their sleep disturbed by wheeze on a weekly basis.

As far as ethnic differences were concerned, Black Caribbeans were around 70 per cent more likely than their White counterparts to have had asthma ( 16.2 per cent compared with 11.6 per cent), while Bangladeshis were much less likely at 5.6 per cent.

When we looked at wheezing in the previous 12 months, more than a quarter of Black Caribbean children had suffered compared with one in five White children, so around 40 per cent more likely. Around half of the disadvantage could be explained by social and economic factors, in particular income and the receipt of benefits.

Once again Bangladeshi children were least likely to have wheezed at less than one in ten , especially if their mother was born abroad and if they were living in a bi-lingual or non-English speaking household.

Black African children had lower asthma and wheezing rates than White children, while Indian and Pakistani children had similar rates to White children.

Lower reported rates

Our research team is inclined to think that the apparent South Asian “advantage” might be due to lower reported rates among the Bangladeshi group and should not be attributed to all Asian groups.

With work in the UK and US suggesting South Asians are more likely to be hospitalised with asthma than White children, there is either a story around levels of severity or under reporting/ under diagnosis among these ethnic groups.

Our data suggests that households that would have the most problems communicating with British health services, (new migrants/those who don’t speak English a home or need the survey translated) are least likely to report asthma and wheeze.

By contrast the Black African group which has a similar migration history to the Bangladeshi group, but where English is spoken more frequently, do not show signs of under-reporting.

Migration status and language are key

In order to avoid potentially misleading reports of low asthma and wheezing illness prevalence in some ethnic groups, we should look carefully at migration history and levels of spoken English, particularly in primary care settings.

Ethnic groups are diverse in terms of the prevalence of asthma and wheezing and in their social and economic profiles.

It is also clear that child health provision needs to be carried out within the unique social, economic and cultural context of each group if progress is to be made.

Further information

Lidia Panico is a researcher based at the French Institute for Demographic Studies.

Ethnic variation in childhood asthma and wheezing illnesses: findings from the Millennium Cohort Study is research published in the International Journal of Epidemiology by Lidia Panico, Mel Bartley, Michael Marmot, James Nazroo, Amanda Sacker and Yvonne Kelly.

Photo credit: KristyFaith

Breastfeeding – to a schedule or on demand?

Mums-to-be are frequently advised in baby books that feeding to a schedule is best for their  child. But what does the evidence tell us when it comes to the different approaches and what might that mean for parents, practitioners and policy makers?

Dr Maria Iacovou from the University of Cambridge presents recent evidence breastfeeding research at an ESRC Centre for Lifecourse Studies Policy Seminar.

Photo credit: clogsilk

Related links

The Effect of Breastfeeding on Children’s Cognitive and Non-cognitive Abilities, Labour Economics 19, 2012.

The effects of breastfeeding on children, mothers and employersResearch project information, Institute for Social and Economic Research, University of Essex.